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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'gov.ora/ehd <br />tir oa`' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Q <br />Date: Z 3 <br />Address: ss <br />0� <br />City: Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: 0! 8 <br />Inspection Type: F --D C4 �- <br />7 <br />B180 Posted Yes <br />No Permit Posted Yes No <br />Re -Inspection on or After: 2sl�a Z 3 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />e <br />SA <br />D� <br />S l <br />/✓i /lpD �OV7 �. <br />o- l l <br />/!1 <br />5- i GLJ <br />A op s, iiec <br />i j, <br />- <br />&er✓Z 0. k-0- <br />o/e ,✓ec / t —Fo119 <br />Temperature <br />Item Location Temperature <br />�.— <br />L / lF- <br />SL.� Ari SCC- ✓i,'aCct, <br />Sl F <br />' 4-14 /S <br />v- <br />/ - n <br />36- <br />k sfa. fry b 4o F <br />ft�e <br />vim <br />ess /P <br />---� �r -iA E� LG' 0 <br />Food Safety certification <br />- Facility Hot Water Tem erature Warewashtng <br />Name: <br />Hand Sink: <br />.F Chlorine: ppm Heat: .F <br />Exp. Date: <br />arewashing Sink: <br />.F oust. Amm.: ppm Other: .F <br />Received By/ Title: <br />�S6u-Sit <br />/COr� <br />EH Specialist: <br />Phone: <br />Time In: <br />Time Out: 2 Page of <br />EHD 16-24 (2n0 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />